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2007 - Intrusion of Overerupted Molars by
2007 - Intrusion of Overerupted Molars by
2007 - Intrusion of Overerupted Molars by
ABSTRACT
This article describes the orthodontic treatment of a 26-year-old female patient with overerupted
left maxillary molar teeth. Her chief complaint was that the maxillary left first and the second molar
intruded into the space required for the mandibular left first and the second molars, preventing
prosthodontic treatment. The authors performed a corticotomy and used orthodontic skeletal an-
chorage with a miniplate and orthodontic miniscrews with a head modified to provide a specially
designed hook. With this approach, they were able to achieve a sufficient amount of molar intru-
sion without discomfort, root resorption, or extrusion of the adjacent teeth. The first molar was
intruded 3.0 mm and second molar was intruded 3.5 mm during 2 months of treatment. These
results have been maintained for 11 months.
KEY WORDS: Intrusion; Orthodontic skeletal anchorage system; Specially designed hook
Hook Fabrication
Just after insertion of the screw type OSAS, an im-
pression was obtained to make a hook. For the work-
ing model, two orthodontic miniscrews (analogous to
an implant) were put inside the impression material
and poured with yellow stone (Figure 3a). The hook
was made with 0.7-mm stainless steel wire, and the
force direction that allows suitable intrusion of over-
erupted molars was considered (Figure 3b,c). Ortho-
dontic miniscrews and the hook were attached using Figure 2. Orthodontic skeletal anchorage system implants. (a, b) On
the buccal side, an L-shaped miniplate was fixed by bone screws,
a metal primer, bonding agent, and resin after each with the short arm exposed to the oral cavity. (c) Two orthodontic
was sandblasted (Figure 3d). miniscrews, 1.6 mm in diameter and 8.0 mm in length, were implant-
ed on the palatal area 2 weeks after the corticotomy.
Treatment Progress and Results
The same day the screw type OSAS was inserted,
a specially designed hook was bonded on the palatal
side. After that, brackets were bonded on the center
of the buccal and lingual faces of the molar, and elas-
Figure 3. Hook fabrication and attachment. (a) An impression was taken, and two orthodontic miniscrews were put inside the impression
material for the working model. (b, c) The specially designed hook for this patient with 0.7-mm stainless steel wire. (d) The hook was attached
by using metal primer, bonding agent, and resin.
tics were used to apply a force of 100 to 150 g on miniscrews were used as a retainer (Figure 5c,d). Dur-
each side (Figure 4a). In this case, the amount of in- ing retention, oral hygiene education was given to the
trusion of the first and second molars should be dif- patients, and no complications occurred.
ferent, so we used a different force between the two Seven months into retention, implant treatment for
teeth. One month after the application of elastic force, prosthetic replacements started. After 1 month of
considerable intrusion had occurred. The mesial mar- prosthodontic treatment, we stopped the retention and
ginal ridge of the maxillary left first molar was level with removed the miniplate and miniscrew. Three months
the distal marginal ridge of the maxillary left second after stopping the retention, the patient had a satisfac-
premolar. However, for correction of the curve of tory occlusion (Figure 5e).
Spee, we continued the force on the maxillary left sec- Cephalometric superimposition showed that the
ond molar and reduced the force on the maxillary left maxillary left first molar had intruded 3.0 mm and the
first molar tooth (Figure 4b). second molar had intruded 3.5 mm (Figure 6; Table
Two months after surgery, the molars were ade- 1). The teeth were tipped about 1⬚ to 3⬚. The posttreat-
quately intruded, and a suitable curve of Spee was ment radiograph demonstrated that the overerupted
present. The overerupted molars were successfully in- molars were successfully intruded without root resorp-
truded without movement of the adjacent teeth, and tion (Figures 7 and 8).
the intruded teeth remained vital (Figure 5). The pa-
tient experienced minimum discomfort and a slight soft DISCUSSION
tissue inflammation around the hook on the palatal It is often difficult to perform prosthodontic treatment
side. The miniplate and one of the two orthodontic for missing molars because of the overeruption of an-
Figure 5. Intraoral photographs of the patient. (a) Pretreatment. (b) Posttreatment. (c, d) The miniplate and one of two orthodontic miniscrews
were used as a retainer during the retention period. (e) After retainer removal.
to use minimal amounts of bonding resin in the at- 13. Kim SC, Min SG, Sh O, Tae GC, Kang KH. The Fast Or-
tachment of the hook and to maintain a clean state in thodontics Through the Surgical Procedure. Seoul, Korea:
Myung Moon; 2004.
the attachment process. In addition, it is recommend- 14. Kinzinger GSM, Gross U, Fritz UB, Diedrich PR. Anchorage
ed that patients be continuously educated on the quality of deciduous molars versus premolars for molar dis-
maintenance of oral hygiene. talization with a pendulum appliance. Am J Orthod Dento-
We achieved a sufficient amount of maxillary molar facial Orthop. 2005;127:314–323.
15. Mostafa YA, Tawfik KM, El-Mangoury NH. Surgical-ortho-
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we very easily created a force parallel with the tooth’s sion with the molar intrusion arch. J Clin Orthod. 2000;34:
long axis, and with this force, we effectively controlled 90–93.
17. Bonetti GA, Giunta D. Molar intrusion with removable intru-
the direction of the tooth movement. There was no root sion. J Clin Orthod. 1996;30:434–437.
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